To amend sections 5162.20 and 5167.12 and to enact sections 3902.65 and 5164.094 of the Revised Code to require health benefit plans and the Medicaid Program to cover epinephrine and glucagon for individuals eighteen years of age and younger and to cap cost sharing for epinephrine and glucagon in any form.
HB915 would require Ohio health benefit plans and the Medicaid program to cover epinephrine and glucagon for individuals age 18 and younger when those medications are medically necessary. The bill applies to epinephrine and glucagon in any prescribed form, not just autoinjectors, and it defines epinephrine and glucagon autoinjectors for purposes of the cost-sharing limits.
For private health plans, the bill would require coverage for medically necessary epinephrine and glucagon for covered persons under 19 and would cap out-of-pocket cost sharing at $60 per two-autoinjector package or $60 per dose equivalent for other prescribed forms. The cap would apply regardless of deductibles, copays, coinsurance, or other cost-sharing rules, though insurers could charge less than the cap. For Medicaid, the bill would require coverage for the same medications for enrollees 18 and younger and would prohibit Medicaid cost-sharing for these drugs from exceeding the limits set for private plans. The bill also amends Medicaid cost-sharing provisions to reference the new coverage requirement and requires Medicaid managed care plans to comply with the new rules.
The bill would change state insurance and Medicaid law by adding new coverage mandates and price protections for pediatric emergency and diabetes-related medications. It would amend Revised Code sections 5162.20 and 5167.12 and create new sections 3902.65 and 5164.094, affecting health plan issuers, Medicaid, Medicaid managed care organizations, providers, and families with children who need these medications. It also preserves existing Medicaid copayment collection rules while tying them to the new coverage mandate.
Because the bill was only introduced and there is no recorded committee testimony or vote history in the provided materials, the overall sentiment cannot be measured from formal action. Based on the bill’s sponsorship and cosponsorship, the measure appears to have been introduced with support from a group of House members and framed as a patient-access and affordability proposal. The policy goal is straightforward and consumer-protective, focusing on reducing barriers to obtaining life-saving medications for children.
The main point of contention is likely cost and mandate scope: insurers and Medicaid administrators may object to required coverage for all medically necessary prescribed forms of epinephrine and glucagon, as well as the fixed cost-sharing cap, because it limits plan design and may increase claims costs. Another possible issue is the age-based cutoff at 18 and younger, which creates a specific eligibility line, and the bill’s application to any prescribed form rather than only autoinjectors, which broadens the mandate beyond the most common delivery devices.
HB915 would add new statutory coverage mandates in Ohio insurance and Medicaid law for epinephrine and glucagon for minors, while capping member cost sharing for those drugs across all prescribed forms. It would create new Revised Code sections 3902.65 and 5164.094, amend Medicaid cost-sharing and managed care provisions in sections 5162.20 and 5167.12, and require health benefit plans, Medicaid, and Medicaid MCOs to align their coverage and cost-sharing practices with the new rules.
The bill appears generally supportive and consumer-focused, with its introduction and cosponsorship suggesting interest in improving access to emergency and medically necessary medications for children. No committee testimony or votes are provided, so there is no recorded opposition or support to gauge beyond the bill’s sponsorship. The measure is framed as a health-access and affordability policy rather than a controversial restructuring of benefits.
The likely areas of contention are the mandate on private insurers and Medicaid to cover epinephrine and glucagon in any prescribed form, the $60 cost-sharing cap, and the administrative and fiscal impact of those requirements. Insurers and program administrators may argue that the bill limits flexibility and could raise costs, while supporters would likely emphasize affordability and access for children with allergies or diabetes-related needs. The age cutoff and the inclusion of all prescribed forms, not just autoinjectors, may also draw scrutiny.